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Patients with HLHS demand considerable inpatient resources, whether treated with the Norwood-Glenn-Fontan procedure pathway or cardiac transplantation. Improved survival rates have led to increased hospital stays and costs.

SUMMARY Left ventricular (LV) size and function were studied by echocardiography in 145 normal children. The LV end-diastolic diameter (EDD) and its percentage change with systole (%ALVD) were measured and mean velocity of circumferential fiber shortening (Vcf) calculated. The LV pre-ejection period (PEP) and ejection time (LVET) were determined from recordings of aortic valve motion.The EDD increased by approximately threefold during childhood and was best correlated with the log of body weight (r = 0. the log of body surface area (r = 0.96). The mean %lALVD was 36 ± 4 (SD), and this index of LV function was independent of age and heart rate. Mean Vcf was higher, and the absolute values of PEP and LVET shorter, in younger children with a faster heart rate. The mean ratio of PEP/LVET was 0.31 ± 0.003, and was relatively independent of age (r = -0.41) and heart rate (r = 0.37). The %ZALVD and PEP/LVET appear to be particularly useful indices of LV function because they remain constant during the course of childhood.casionally a shallow left lateral decubitus position was required to record the ventricular septum clearly. Left ventricular dimensions were measured in the standard manner ( fig. 1). End-diastolic diameter (EDD) was measured at the start of the QRS complex. End-systolic diameter (ESD) was measured at the point in late systole where the septum and LV posterior wall were in closest apposition. These measurements were made with the transducer angled slightly inferiorly and laterally from the point of maximal excursion of the mitral valve in subjects over one year of age. In younger children, as previously noted by Sahn et al.,7 the mitral leaflets appear to extend farther toward the apex, and the LV diameter decreases rapidly as the transducer is directed below the mitral valve. Therefore, in infants under one year of age the LV dimensions were measured at the point of maximal excursion of the mitral valve, from a position from which both leaflets could be visualized. Recordings satisfactory for determination of LV dimensions were obtained in 143 of the 145 subjects (99%).Left ventricular systolic time intervals were determined from recordings of the aortic valve at 100 mm/sec paper speed ( fig. 2)

A diagnosis of congenital heart disease adds significant incremental risk of mortality in children requiring inpatient noncardiovascular surgery. This outcome difference is present for both minor and major surgical procedures, and regardless of whether mortality is measured at 1, 3, or 30 days. The incremental risk is greatest in neonates and infants where the presence of congenital heart disease is associated with a 2-fold increase in mortality from noncardiac surgery.